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TREATING VARICOSE VEINS

Belhoul European Hospital, Dubai.

What is the problem and why do varicose veins appear?

Varicose veins are the result of a weakness in the vein wall that is in some cases familial. The problem is due to hyper pressure or high pressure in the superficial venous system. This high pressure disrupts the structures inside the vein, which bring back blood to the heart. This weakness causes distension of the vein and secondary incompetence of the unidirectional valve systems attached to the walls of the vein.

Unlike the arterial system, in the venous system, there is no pumping mechanism to ensure the return flow of blood from the extremities, back to the heart. However, multi-factors are involved in doing this task. Respiration creates a negative, aspiratory pressure, which helps blood in the venous vessels to go back to the heart. Secondly, the unidirectional valves in the veins enable blood flow to the heart, by creating a low pressure, which is unidirectional. Therefore blood does not flow backward from these valves. Thirdly, muscle tone and muscle contraction brought about by movement of the lower limbs, particularly, during walking, running, etc., apply pressure on these veins creating an influx of blood which will go back to the heart. Varicose veins occur when there is disruption of these mechanisms.

Why is it that some people get varicose veins and not others?

It is true that females are more prone than males. There is also a heredity factor associated with the condition. Some families do develop varicose veins much more than others. Gravity is a very important factor in varicose veins. The incidence of the problem is higher in people who are inactive, are immobile for long periods of time, are standing for long hours because their jobs demand it because these features make the return of blood from the lower limbs to the heart, more difficult.

How are varicose veins different from spider veins?

By definition, spider veins present an aesthetic problem and sometimes it is very, very bad. But it has no functional problem. One can have only spider veins, only varicose veins or have both, simultaneously. They are very small veins immediately below the skin surface and are very, very superficial. They can happen in the leg, on the abdominal wall.

What are the symptoms of varicose veins and how do they manifest in their earliest form?

They are painful and tortuous. But before this we have preliminary symptoms that will indicate to us that something is wrong with the venous system. First of all is heaviness after standing for an hour or two. You would feel as if your legs are heavier than the whole body. When you want to move, you feel a numbness; you feel your foot and leg have increased in volume.

What is the relation between varicose veins and Deep Vein Thrombosis (DVT)?

We have two venous systems: the deep venous system and the superficial venous system, which are interconnected by perforant veins. It is very, very important to note that these two systems are complementary and that, if the deep system is fine and patent, we can then remove the whole superficial system without any problem. On the other hand, if the deep system is occluded, the superficial system takes all the importance and therefore removing it, would become dangerous.

How can this be ensured?

We diagnose this by Doppler ultrasound of the lower limb where we can identify any problem in the deep vein system.

What is the correlation between pregnancy and varicose veins?

Pregnancy can also cause varicose veins, as a temporary phenomenon. Anything that increases the pressure in the superficial venous system will help create distension of the veins, leading to varicose veins by disrupting these very fine structures of the valves. So, pregnancy creates high pressure and sometimes the gravity will push the uterus on the inferior vena cava, which is the tube carrying blood, up, to the heart.

How is varicose veins diagnosed?

Diagnosis of varicose veins is usually clinical, with history taking and physical examination of the affected region. In some cases, it is better to go for a complementary investigation with the Echo Doppler. This examination, if done properly, will give us the exact situation with respect to the pressure inside the veins and the arteries.

How are varicose veins treated?

The severity of the condition is graded from 1 to 6. Grade 1 and 2 are very common and don’t require surgery or any special treatment. They are often accompanied with spider veins. Grades 3 and 4 are as common. These definitely need surgical treatment or long-term medical treatment. It is a must to perform surgery on Grades 5 and 6, at the earliest possible. We give the patients medication, which help the contraction of the veins and thus push the blood up. The other thing is to prohibit people from wearing tight clothes on the lower abdomen, particularly, tight belt and jeans that might affect the pouring of blood from the superficial system to the deep one. Using elastic socks if you have varicose veins and also after surgery for the condition.

When should surgery be undertaken?

Ideally, before complications set in, in grades 3 and 4. This doesn’t include the symptoms of heaviness, numbness and oedema. But surgery should be performed before the skin manifestations. Surgery is simple and may be done under local or general anaesthesia.